Provider Demographics
NPI:1730286147
Name:CHAMBERS, EDFORD OLAF III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDFORD
Middle Name:OLAF
Last Name:CHAMBERS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1630
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1630
Mailing Address - Country:US
Mailing Address - Phone:301-475-1692
Mailing Address - Fax:301-997-0912
Practice Address - Street 1:22650 CEDAR LANE CT
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-1630
Practice Address - Country:US
Practice Address - Phone:301-475-1692
Practice Address - Fax:301-997-0912
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044310207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118N-023GMedicare ID - Type Unspecified
MDF62692Medicare UPIN